Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department

Abstract

Phone calls to patients after discharge from the emergency department (ED) serve as reminders to schedule medical follow-up, support adherence to discharge instructions, and reduce revisits to already-crowded EDs. An existing, nurse-administered, call-back program contacted randomly selected ED patients 24 to 48 hours following discharge. This program did not improve patient follow-up (48.68%) nor reduce the ED revisit rate (6.7% baseline vs 6.0% postimplementation). Plan-Do-Study-Act methodology tested a modification to the existing program consisting of a second, scripted phone call from a trained volunteer at 72 to 96 hours postdischarge. Volunteers utilized a patient list and script, and nurses provided expertise to eliminate identified barriers to follow-up. Follow-up rate and ED revisit were monitored through the electronic medical record. A total of 894 patients participated between October 2017 and June 2018. Follow-up increased from 48.68% to 65.5% ( P < .0001) and ED revisit decreased significantly (4.5% vs 8.6%, P < .001). This innovative nurse-led, systematic postdischarge call-back program utilizing hospital volunteers increased patient compliance with post-ED medical follow-up while significantly reducing the rate of patient revisit to the ED within 7 days of discharge.

Nurse‐led supportive Coordinated Transitional Care (CTraC) program improves care for veterans with serious illness

“…However, traditional protocols focused on decreasing 30‐day readmissions may not meet the needs of patients with serious‐illness who often require many months of intensive case management to attain high‐quality end‐of‐life care. Our work adds to the body of evidence that nurse‐driven models can influence outcomes such as earlier documentation of advance care planning and increased hospice use and length of stay 44–46 . Our work is distinguished by the novel delivery of supportive care in the context of a nurse‐led transitional care program rather than a palliative care program.…”

“…Our work adds to the body of evidence that nurse-driven models can influence outcomes such as earlier documentation of advance care planning and increased hospice use and length of stay. [44][45][46] Our work is distinguished by the novel delivery of supportive care in the context of a nurseled transitional care program rather than a palliative care program. This model empowers nurses to act as independent clinicians who identify patients in need well before referrals to palliative care and hospice are typically made.…”

Evaluating the utility of telehealth in emergency medicine

“…Two recent studies were, however, able to achieve reductions in representations. Fruhan et al 25 reported a reduction in representations from 6.2% to 4.6% at 72 h when offering tele-follow up from an advanced practice clinician able to provide a teleconsult and Luciani-McGillivray et al 26 achieved a reduction from 8.6% to 4.5% (P < 0.001) through actively working to remove barriers to follow up through booking appointments and troubleshooting logistical issues (transportation, finance or social service referrals) when required.…”

Emergency Department Care Transition Programs—Value-Based Care Interventions That Need System-Level Support

“…This article is an important contribution to the existing literature on how to improve post-ED care and care transitions and prevent unnecessary ED revisits and hospitalizations. Although prior studies of ED-directed callback programs have shown that they can improve outpatient follow-up, 2,3 the association of these programs with ED revisit rates and hospitalization rates have been mixed. Like Fruhan and Bills, 1 Luciani-McGillivray et al 2 found that their program decreased the number of unplanned ED revisits, whereas other callback programs had no association with ED revisits, [3][4][5] hospitalizations, [3][4][5] or costs of care.…”

“…Although prior studies of ED-directed callback programs have shown that they can improve outpatient follow-up, the association of these programs with ED revisit rates and hospitalization rates have been mixed. Like Fruhan and Bills, Luciani-McGillivray et al found that their program decreased the number of unplanned ED revisits, whereas other callback programs had no association with ED revisits, hospitalizations, or costs of care . Future research is needed to understand this variation.…”